Modelling the HIV epidemic among MSM in the United Kingdom: quantifying the contributions to HIV transmission to better inform prevention initiatives

作者：Punyacharoensin Narat^*; Edmunds William John; De Angelis Daniela; Delpech Valerie; Hart Graham; Elford Jonathan; Brown Alison; Gill Noel; White Richard G

来源：AIDS, 2015, 29(3): 339-349.

DOI：10.1097/QAD.0000000000000525

• compartmental model
• epidemic model
• HIV/AIDS
• homosexual
• mathematical model
• MSM

Objectives: HIV is a major public health problem among MSM in the United Kingdom with around 2400 new infections annually. We quantified the contribution of biological and behavioural factors.
Design: Modelling study.
Methods: A partnership-based model of HIV transmission among UKMSMaged 15-64 years was developed and calibrated to time series HIV prevalence. The calibration was validated using multiple surveillance datasets. Population-attributable fractions were used to estimate the contribution of behavioural and biological factors to HIV transmission over the period 2001-2002, 2014-2015, and 2019-2020.
Results: The contribution of most biological and behavioural factors was relatively constant over time, with the key group sustaining HIV transmission being higher-sexual activity MSM aged below 35 years living with undiagnosed HIV. The effect of primary HIV infection was relatively small with 2014-2015 population-attributable fraction of 10% (3-28%) in comparison with other subsequent asymptomatic stages. Diagnosed men who were not on antiretroviral therapy (ART) currently contributed 26% (14-39%) of net infections, whereas ART-treated MSM accounted for 17% (10-24%). A considerable number of new infections are also likely to occur within long-term relationships.
Conclusion: The majority of the new HIV infections among MSM in the United Kingdom during 2001-2020 is expected to be accounted for by a small group of younger and highly sexually active individuals, living with undiagnosed HIV in the asymptomatic stage. Bringing this group into HIV/AIDS care by improving testing uptake is a vital step for preventing onward transmission and will determine the success of using ART as prevention.

• 出版日期2015-1-28